scholarly journals Plaučių chondrohamartomų diagnostika

2004 ◽  
Vol 2 (3) ◽  
pp. 0-0
Author(s):  
Aba Vitėnas

Aba VitėnasVšĮ Vilniaus universiteto ligoninės "Santariškių klinikos"Centro filialas, Radiologijos skyrius,Žygimantų g. 3, LT–01102, VilniusEl. paštas [email protected] Įvadas / tikslas Plaučių disontogeniniai navikai – hamartomos – yra dažniausi iš visų periferinių nepiktybinių rutulinių plaučių darinių. Endobronchinė centrinė hamartoma (epistoma) pasitaiko labai retai. Kremzlinės struktūros plaučių hamartomos – chondrohamartomos ir osteochondrohamartomos – yra dažniausios. Darbo tikslas – apibūdinti plaučių hamartomas, sukonkretinti jų rentgenologinius diferencinės diagnostikos žymenis ir tuo remiantis – klasifikaciją. Ligoniai ir metodai Plaučių hamartomos buvo nustatytos 43 ligoniams – 16–78 metų 28 vyrams ir 15 moterų. Visiems ligoniams atliktas kompleksinis radiologinis tyrimas – polipozicinė rentgenoskopija, rentgenografija, tomografija, skaitmeninė fluorografija, kompiuterinė tomografija. Bronchoskopija ir biopsija padaryta 31 ligoniui. Buvo atliekami ir kiti tyrimai: ultragarsinis, funkciniai plaučių mėginiai, specifinės laboratorinės reakcijos diferencinei diagnostikai nuo plaučių tuberkuliozės, kolagenozės, echinokokozės, alergozės. Rezultatai 42 ligoniams diagnozuota periferinė ir vienam – centrinė hamartoma. Tipinė plaučių hamartomos lokalizacija – dešiniojo plaučio apatinė skiltis (21 ligonis, arba 49%). Centrinė endobronchinė hamartoma diagnozuota 42 metų ligoniui, ilgai sirgusiam lėtiniu bronchitu ir dažnai plaučių uždegimu. Operuota 30 ligonių. Devyni ligoniai iš 13 neoperuotųjų stebėti nuo 1 iki 14 metų. Periferinės hamartomos dažniausiai buvo besimptomės. 23 ligoniams hamartoma nustatyta atsitiktinai profilaktiškai tiriant plaučius dėl įvairių pilvo organų ligų arba atliekant fluorografinį tyrimą. Kitiems tirtiesiems hamartoma buvo diagnozuota sergant plaučių ligomis, tuberkulioze, alergoze, kolagenoze, įvairiais navikais. Dvylikai ligonių nepiktybinio plaučių naviko, arba hamartomos, diagnozė buvo tiksliai nustatyta poliklinikoje. Devyniems buvo įtartas pirminis vėžys arba metastazė, šešiems – specifinis infiltratas arba tuberkuloma, vienam – eozinofilinis infiltratas, vienam – echinokokas. Hamartoma 31 ligoniui buvo dešiniajame, 12 – kairiajame plautyje. Rentgenogramoje periferinė hamartoma buvo matoma apskritos formos ir ryškių kontūrų. Jos rentgenologinė struktūra buvo nevienoda. Šviesi (nekalcifikuota) hamartoma buvo matoma 14 ligonių. Kitiems 28 ligoniams diagnozuota kalcifikuota (inkrustuota arba tamsi) hamartoma, t. y. hamartochondroma (chondrohamartoma, osteochondrohamartoma). Išvados Nors plaučių hamartomos auga labai lėtai, pasitaiko labai greitai progresuojančių: 3 ligoniams, arba 7%, hamartomos per metus padidėjo iki 50%. Dažniausias jų variantas – hamartochondroma (chondrohamartoma). Piktybinių hamartomų nediagnozuota. Pagal neoplazinės kalcinozės laipsnį plaučių hamartomos radiologiškai skirstomos į tris variantus: šviesas, inkrustuotas ir tamsias. Radiologai gali diferencijuoti dažniausius plaučių hamartomų variantus, tarp jų chondrohamartomas ir osteochondrohamartomas. Reikšminiai žodžiai: disontogeniniai plaučių navikai, disembriomos, periferiniai plaučių navikai, hamartomos, hamartochondromos, neoplazinė kalcinozė, rentgenodiagnostika Diagnostics of pulmonary chondrohamartomas Aba Vitėnas Background / objective Hamartomas, as dysontogenic tumours, are most common among all peripheral non-malignant "spheral" pulmonary formations. Endobronchial central hamartoma is rare and is usually diagnosed as "epystoma" (bronchial obturator). Among peripheral hamartomas, tumours of cartilaginous structure (chondrohamartomas and ostheochondrohamartomas) are particularly common. The objective of the work was to describe pulmonary hamartomas and to concretize most common variations of hamartoma and their different radiological signs. Patients and methods Forty-three patients were diagnosed with pulmonary hamartoma (28 males and 15 females, 16–78 years old). In the hospital, clinical and laboratory tests were performed for all patients; complex radiological examination: polypositional X-ray radioscopy, radiography, tomography, digital fluorography, computed tomography. Thirty-one patients underwent bronchoscopy and biopsy, sonoscopy, functional lung tests, specific reactions. Results Forty-two patients had peripheral and one central hamartoma. The most typical localization of pulmonary hamartoma was the lower lobe of the right lung (21 patients, 49%). A central endobronchial hamartoma was diagnosed for a 42-year-old patient who had been ill for a long time with chronic bronchitis and frequent pneumonias. 30 pacients were operated one. From 13 non-operated patients, 9 were followed up in dynamics for 1–14 years. Peripheral hamartoma usually was asymptomatic. Twenty-three patients were diagnosed occasionaly during preventive pulmonary evaluation in case of different abdominal diseases or during fluorography. The others diagnosed as having hamartoma were ill with lung diseases, TBC, alergosis, collagenosis, different tumours. In out-patient settings, correct diagnosis of benign tumour or hamartoma was established for 12 patients, 9 were suspected as having cancer or metastases, 6 – specific infiltrate (tuberculoma), 1 – eosinophilic infiltrate and 1 – echinococcus; 31 patient had the tumour in the right, and 12 patients in the left lung. Radiologically, hamartoma is a spheric tumour with clear margins. As to the structure of the tumour, 14 patients had non-calcificated, "light" hamartoma, 28 had calcificated, "inlaid" and "hard" hamartochondroma. Thus, neoplastic calcinosis is characteristic of chondrohamartomas (osteochondrohamartomas) and occurs twice as often as hamartomas of other types. Conclusions Althought hamartomas grow very slowly, there were rapidly increasing ones: for 3 patients (7%) the volume of hamartoma increased by 50% in a year. The most common type was hamartochondroma (chondrohamartoma). There were no malignant hamartomas. Therefore radiologists can diagnose most common variations of hamartomas as "light", "inlaid" and "hard" ones. Keywords: dysontogenous pulmonary tumours, dysembriomas, peripheral pulmonary tumours, hamartomas, hamartochondromas, neoplastic calcinosis, radiological diagnostics

2020 ◽  
pp. 90-95
Author(s):  
M. Opanasenko ◽  
◽  
L. Levanda ◽  
A. Tereshkovich ◽  
I. Liskina ◽  
...  

Introduction. Foreign bodies in the airways are a very urgent problem that occurs at any age and quite often requires an urgent and sometimes urgent assessment of the situation, examination, and making the right decision. According to statistics, most often foreign body in airway are found in childhood. In about 95–98% of cases, this pathology is recorded in children aged 1.5 to 3 years. This is due to the behavior of children, their anatomical and physiological characteristics and underdevelopment of protective reflexes. Among all cases of foreign body in airway, foreign bodies of the larynx are found in 12%, trachea – in 18%, bronchus – in 70% of cases. In 80% of cases, CTs enter the right bronchus, as it is a broader and more direct continuation of the trachea. The correct diagnosis is established early after CT aspiration in 40–57% of patients. The mortality rate varies, according to different authors, from 2 to 15%. Clinical case. The boy V., born in 2008. was admitted to the Department of Pediatric Pulmonology on May 30, 2019, with complaints of frequent unproductive cough, mainly daytime, increasing with physical exertion, sometimes subfibril body temperature, weakness, lethargy, decrease appetite. These complaints have been observed for the third time in the last six months. Diagnosis: Foreign body B10 of the left lung. Conclusions. Aspiration of a foreign body into the respiratory tract most often occurs in early childhood (1–3 years). The clinical picture in the early stages is asymptomatic, and over time it leads to the development of inflammatory changes in the lungs, are treated conservatively. Given the complexity of diagnosis, aspiration of a foreign body can lead to frequent recurrent pneumonia, the formation of bronchiectasis in the lower parts of the lungs, which may require surgical treatment. The gold standard of diagnostics is fibrobronchoscopy and spiral computed tomography of the thoracic cavity (SCT OGK), with the help of which, early after aspiration, a foreign body can be detected and subsequently excluded from the respiratory tract. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an participating institution.The informed consent of the child’s parents was obtained from the studies. No conflict of interest was declared by the authors. Key words: child, lungs, foreign body.


2014 ◽  
Vol 117 (5) ◽  
pp. 535-543 ◽  
Author(s):  
Justin A. R. Lang ◽  
James T. Pearson ◽  
Arjan B. te Pas ◽  
Megan J. Wallace ◽  
Melissa L. Siew ◽  
...  

At birth, the transition to newborn life is triggered by lung aeration, which stimulates a large increase in pulmonary blood flow (PBF). Current theories predict that the increase in PBF is spatially related to ventilated lung regions as they aerate after birth. Using simultaneous phase-contrast X-ray imaging and angiography we investigated the spatial relationships between lung aeration and the increase in PBF after birth. Six near-term (30-day gestation) rabbits were delivered by caesarean section, intubated and an intravenous catheter inserted, before they were positioned for X-ray imaging. During imaging, iodine was injected before ventilation onset, after ventilation of the right lung only, and after ventilation of both lungs. Unilateral ventilation increased iodine levels entering both left and right pulmonary arteries (PAs) and significantly increased heart rate, iodine ejection per beat, diameters of both left and right PAs, and number of visible vessels in both lungs. Within the 6th intercostal space, the mean gray level (relative measure of iodine level) increased from 68.3 ± 11.6 and 70.3 ± 7.5%·s to 136.3 ± 22.6 and 136.3 ± 23.7%·s in the left and right PAs, respectively. No differences were observed between vessels in the left and right lungs, despite the left lung not initially being ventilated. The increase in PBF at birth is not spatially related to lung aeration allowing a large ventilation/perfusion mismatch, or pulmonary shunting, to occur in the partially aerated lung at birth.


2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Mohammad Ashkan Moslehi ◽  
Mohammad Hadi Imanieh ◽  
Ali Adib

Foreign body aspiration (FBA) is a common incidence in young children. Leeches are rarely reported as FBA at any age. This study describes a 15-year-old female who presented with hemoptysis, hematemesis, coughs, melena, and anemia seven months prior to admission. Chest X-ray showed a round hyperdensity in the right lower lobe. A chest computed tomography (CT) demonstrated an area of consolidation and surrounding ground glass opacities in the right lower lobe. Hematological investigations revealed anemia. Finally, bronchoscopy was performed and a 5 cm leech was found within the rightB7-8bronchus and removed by forceps and a Dormia basket.


Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4541-4541 ◽  
Author(s):  
Roberta Miyeko Kato ◽  
Thomas Hofstra ◽  
Herbert J. Meiselman ◽  
Henry Jay Forman ◽  
Abe Abuchowski ◽  
...  

Abstract Acute chest syndrome (ACS) is a potentially fatal complication of sickle cell disease (SCD) and is characterized by opacification of the chest x-ray (CXR) and progressive pulmonary failure due, in part, to intra-pulmonary sickling. The ACS process can proceed very rapidly from a small area of lung involvement in one lobe to total opacification of the lung and pulmonary failure within 12 to 24 hours. In the early phases of this process, oxygenation and pulmonary function may be preserved. In the face of rapidly progressing CXR changes, the ACS process may be reversed if diagnosed early and managed by emergent transfusion to decrease the percent of sickle red blood cells (SRBC). A 10 years old African American child with hemoglobin SC type SCD was transferred to our institution with fever and right upper lobe consolidation. Her respiratory rate was 23 breaths/min, SpO2 was 95% breathing room air. Serial CXR showed opacification of the entire right lung and part of the left lower lobe over a 12-hour period (Panel A). Because of the rapid progression, transfusion was recommended. However, because of the family's Jehovah's Witness religious faith, transfusion was refused. PEG-COHb is in clinical development for the treatment of SCD and is designed to deliver preloaded carbon monoxide (CO), pick up O2, and deliver O2 to hypoxic tissue. PEG-COHb serves as a vasodilator and anti-inflammatory agent. It has been shown to have anti-sickling properties in vitro (ASH Abstract 1372, 2014). The agent was obtained from Prolong Pharmaceuticals via an emergency IND (16432) from the FDA. The agent was acceptable to the family and church elders. After written consent was obtained, 500 cc were infused according to dosing information obtained from Prolong Pharma. The CXR (Panel A) 3 hours before infusion shows opacification of the right lung and the left lower lobe. A CXR obtained one hour after infusion showed no worsening, and the CXR (Panel B) obtained 29 hours after Panel A shows significant improvement in the opacification of the lower lobes. The right upper lobe consolidation was likely bacterial pneumonia, and would not be expected to clear rapidly. The patient was mildly hypertensive for age (138/72 mmHg) prior to PEG-COHb infusion. Her blood pressure rose to 153/85 mmHg during infusion; the infusion was stopped and anti-hypertensives were administered. The infusion was restarted at a lower infusion rate and completed in 6 hours instead of the planned 4 with no untoward effects. She was discharged 4 days after the infusion. There were no other serious adverse events clearly related to the drug. There were significant laboratory abnormalities and transaminases that were most likely falsely elevated due to interference of the PEG-COHb with the laboratory methods. Continuous non-invasive monitoring of carboxyhemoglobin showed basal levels of 7% rose to 24% during infusions and returned to normal prior to discharge. Continual recording of SpO2, methemoglobin, heart-rate variability and blood rheological measures showed no significant abnormalities. The rapid reversal of radiographic features consistent with progressive "pure ACS" secondary to the right upper lobe infectious process suggests that PEG-COHb may be an effective treatment for sickle cell related ACS. SHAPE Figure 1. Panel A demonstrates the chest x-ray 3 hours prior to PEG-COHb with right upper lobe consolidation and evolving bilateral lower lobe consolidation and Panel B 29 hours following administration of PEG-COHb demonstrating improvement in the lower lobes. Figure 1. Panel A demonstrates the chest x-ray 3 hours prior to PEG-COHb with right upper lobe consolidation and evolving bilateral lower lobe consolidation and Panel B 29 hours following administration of PEG-COHb demonstrating improvement in the lower lobes. Disclosures Off Label Use: SANGUINATE (pegylated carboxyhemoglobin bovine) is 40 mg/mL of purified bovine hemoglobin that has been pegylated, saturated with carbon monoxide, and dissolved in a buffered saline solution.. Abuchowski:Prolong Pharmaceuticals: Employment. Parmar:Prolong Pharmaceuticals: Employment.


2014 ◽  
Vol 7 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Guergana Petrova ◽  
Penka I. Perenovska ◽  
Dimitrinka Miteva ◽  
Radost T. Kabakchieva ◽  
Ognyan G. Brankov ◽  
...  

SummaryPneumonia is an inflammatory lung disorder characterized by consolidation due to presence of exudates in the alveolar spaces. Most pneumonias can be effectively treated with appropriate oral antibiotics, with intravenous antibiotics being reserved for those with severe infections. We present two cases of girls admitted in our clinic with pneumonia where our conventional therapy was not sufficient. Case 1: A 15-year-old girl with cystic fibrosis, with left lobular pneumonia, for which an aggressive conservative treatment was initiated. After significant improvement, sudden detorioration and pneumothorax of the left lung occurred. She was transferred to the surgical department for intervention. Due to failure to respond to initial drainage she underwent thoracotomy and resection of the left lower lobe of the lung. The histology result confirmed gangrene. Case 2: A four-year old girl was treated for pneumonia in the right lung with aggressive intravenous antibiotic. After temporary improvement sudden deterioration was observed. The patient was transferred to the surgery department, where pulmonary gangrene was confirmed. After the lower lobe of the right lung was resected, she was discharged in good health. The careful follow up, accurate diagnosis and correct medication choice are crucial for reducing the complications of “common” pneumonia.


2021 ◽  
Vol 29 (5) ◽  
pp. 624-628
Author(s):  
S.A. Plaksin ◽  

Cystic hamartoma refers to rare benign lung tumors. The literature describes 17 cases of this disease. The tumor may look like multiple bilateral cysts or a solitary single-chamber or multi-chamber cyst of a large size, which makes it difficult to diagnose. The disease can be complicated by spontaneous pneumothorax. The cyst itself often looks like a pneumothorax. An observation of a 52-year-old man complaining of chest pain and shortness of breath is presents. On the x-ray, the left lung is compressed with air, which is regarded as a spontaneous pneumothorax. Two-day drainage did not give any results. The video-assisted thoracoscopic surgery technique was performed and a large air cyst was detected. A conversion to a thoracotomy was made. A cyst of 20×15 cm size originated from the lower lobe, the lung was in atelectasis. Cyst resection and lung decortication were performed. Histological examination of the cyst wall revealed a hamartoma of the lung. The postoperative period was uneventful. Differential diagnosis of cystic hamartoma is conducting with lymphangioleiomyomatosis, air cysts, extrapulmonary sequestration, echinococcal cysts, and lung cancer. Indications for surgery are the following: chest pain, shortness of breath, pneumothorax, and hemoptysis. In a unilateral process, a cyst resection or lobectomy have to be performed. Cystic pulmonary hamartoma should be included in the differential diagnostic range in patients with recurrent spontaneous pneumothorax, hemoptysis, single and multiple lung cysts. It is impossible to determine the diagnosis without a biopsy and histological examination.


1979 ◽  
Vol 47 (6) ◽  
pp. 1201-1206 ◽  
Author(s):  
J. O. Nilsestuen ◽  
R. L. Coon ◽  
F. O. Igler ◽  
E. J. Zuperku ◽  
J. P. Kampine

Recent studies have indicated that the breathing frequency responses to inspired CO2 in part result from changes in pulmonary stretch receptor activity. Pulmonary CO2 may alter frequency by direct inhibition of stretch receptor discharge, or secondarily, by changes in airway mechanics. The vascularly isolated left lower lobe (LLL) of the canine lung was used to determine the effect of hypocapnic airway constriction on the pulmonary CO2 reflex. The upper and middle lobes of the left lung were removed and the right vagus nerve sectioned. Blood was recirculated through the LLL. Diaphragm electromyogram was used as an index of respiratory center activity and to trigger ventilation of the left lower lobe. Lobar hypocapnia increased peak airway pressure and reduced respiratory rate. However, infusion of isoproterenol or the use of a mechanical overflow system to block the airway pressure response prevented the frequency changes associated with CO2. Although both the direct and mechanical effects of CO2 on stretch receptors may contribute to the reflex, in the LLL preparation the mechanical effects predominate.


1982 ◽  
Vol 52 (6) ◽  
pp. 1591-1597 ◽  
Author(s):  
J. R. Snapper ◽  
T. R. Harris ◽  
K. L. Brigham

The effects of changing cardiac output and lung mass on pulmonary capillary surface area, lung water, and hemodynamics were studied in eight sheep. 51Cr-erythrocytes, 125I-albumin, 3H2O, and [14C]urea were injected into the right atrium, and timed samples were collected from the aorta for the calculation of cardiac output (CO), extravascular lung water (EVLW), and permeability-surface area product (PS) for [14C]urea. CO was varied by opening and closing arteriovenous shunts, and lung mass was decreased by first tying off the left lung followed by tying off the right lower lobe. Pulmonary arterial pressure (r = -0.741) and pulmonary vascular resistance (r = -0.700) increased as lung mass was decreased. CO decreased slightly (r = -0.470 while left atrial pressure was not changed (r = -0.144) by decreasing lung mass. There was a close correlation between EVLW and lung mass (r = 0.944) and between [14C]urea PS and lung mass (r = 0.672). We were able to demonstrate that [14C]urea behaves as a diffusion-limited tracer in a single pass through the lungs, since [14C]urea extraction decreased as flow per unit mass increased. These results support the clinical use of multiple-tracer studies to measure EVLW and [14C]urea PS.


2021 ◽  
Vol 12 (4) ◽  
pp. 53-56
Author(s):  
Premavathy Dr. Dinesh

Lungs are paired conical organs present in the thoracic cavity, which are responsible for gaseous exchange for oxygenation of blood. Both the lungs are divided into lobes by fissures. The right lung is divided into upper, middle and lower lobes by two fissures. The fissures are horizontal and oblique fissure whereas the left lung is divided into upper and lower lobes by oblique fissure. The left lung is divided into upper and lower lobe by oblique fissure. Both the lungs have ten bronchopulmonary segments (structurally separate and functionally independent units). Embryological evidence showed that the lungs developed from the endodermal counterpart of the foregut. Around 22 days of embryonic period, diverticulum are develop, then between 26-28 days lung buds develop. The right bronchial buds and left bronchial buds are branched into secondary and tertiary buds at 5th and 6th week of embryonic life consecutively. During routine anatomy dissection and demonstration in the Department of Anatomy, a 50 year old male cadaver showed anatomical variation in the right lung. The present study observed that the right lung showed partial horizontal fissure. The reason for partial or incomplete fissure formation is due to incomplete or absence of obliteration of prenatal fissure which indicates partial fusion of lobes, generally fissures separating the broncho-pulmonary segments in prenatal life. The reports says that incomplete fissures of the lung may lead to spread of infection like pneumonia to adjacent lobe and collapse in endobronchial lesions and gradation of the fissures of the lungs are very important for lung surgeries. The present study concludes that the knowledge of anatomical variation of lung is of utmost important in the field of pulmonary medicine.


2012 ◽  
Vol 1 (1) ◽  
pp. 33-36
Author(s):  
R Thapa ◽  
M Lakhey ◽  
U Shrestha

Sclerosing haemangioma is a rare neoplasm of the lung which behaves in a clinically benign fashion. Herein, a case of sclerosing haemangioma of the lung in a 52 years old woman is reported. She presented with symptoms of cough and chest pain. Chest X-ray and CT scan showed a well-defined lesion in lower lobe of left lung. Bronchoscopic biopsy findings were suggestive of a carcinoid tumor. Later the tumor was removed by lobectomy. The distinctive constellation of histologic findings revealed it to be a sclerosing haemangioma. DOI: http://dx.doi.org/10.3126/jkmc.v1i1.7254 Journal of Kathmandu Medical College, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 pp.33-36


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